I have just received the Winter Newletter from Anaphylaxis Canada and in it there is an article outlining changes to the instructions and consumer information for the EpiPen.

I have a question about the statement that the EpiPen is no longer indicated on the product monograph for the treatment of a severe asthma attack.

Are they saying that epinephrine is not useful in the case of a severe asthma attack and therefore should not be used? What then is the best course of action?

In a school setting, it was reassuring to be able to tell teachers that they did not need to determine whether it was asthma or anaphylaxis when an at risk child was having difficulty breathing because the treatment was the same. What should we be telling them now??

For those who haven't seen the article yet there are other interesting changes.:

1. The instructions no longer say to "jab" the EpiPen into the thigh but to "place and push firmly" (The EpiPens were being applied with more force than was required!)

2. The instructions no longer say to hold the EpiPen in place for 10 seconds. The new language says "several seconds" is plenty of time.

3. Also the weight recommendations are changing. The EpiPen junior is now recommended for children 15-30 kg. You need to talk to your allergist about proper dose for those under 15kg.

I noticed the statement about the EpiPen no longer being indicated for severe asthma attacks as well and it really bothered me. I've contacted AC about this to see if I can get more info about why the product monograph would have changed.

The instructions no longer say to hold the EpiPen in place for 10 seconds. The new language says "several seconds" is plenty of time.

I find this interesting because when my son had his reaction in August, he hit my arm when I administered his Twinject, which immediately pulled the injector out of his thigh. I freaked out because it was only in his thigh for a split second and worried that he didn't get enough epinephrine. It was amazing how quickly it worked. I later found out through our allergist who had a copy of the hospital report that his oxygen levels were very good (I think 98%) when he was admitted. Only a maximum of 3-5 minutes from when I had given him ephinephrine and he was gasping for breath at the time. I later spoke to the ER doctor (and our allergist) about what had happened and both independently said that he would have gotten enough medicine with the initial injection (without having to wait the 10 seconds).

Given how quickly the epinephrine relieved my son's breathing crisis really makes me question why they wouldn't recommend using it in an emergency for a severe asthma attack. After what we experienced, I wouldn't hesitate to use epinephrine again for any severe breathing difficulties, asthma OR anaphylaxis related. In an emergency the cause for breathing difficulty isn't always clear -- why take the chance pondering the cause in the moment when seconds count if it will reverse the crisis? Karen, It'll be interesting to hear what Anaphylaxis Canada says.

I contacted King Pharma Canada (the new makers of the EpiPen) at the number given in the article about this and all the woman was able to tell me is that they changed the guidelines order to be in line with international guidelines. She wasn't able to give details about the implications on the asthma front.

Karen, I hope you have more luck with Anaphylaxis Canada. I will be seeing our allergist with Tristan later in January and will ask him his opinion as well. I will share back.

Regarding the *10 second rule*. I recently did some experimenting with an expired epi-pen.

Anyone that has ever used an epi-pen, whether in an emergency, or practicing with an expired one, will have noticed there is a *click* when the mechanism goes off and the shot is injected. I removed the pen from the fruit immediately when I heard that click and watched the tip of the sharpie. Two more drops came out of the end of it. I doubt that those two drops would make a big difference in the outcome -- but, I'll still hold the pen in place in an emergency, because i'd rather have those two drops in than out.

_________________self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings

I think I'll still count to 10 too. I'm too conditioned now. (I've played and replayed the scenario in my heads so many times now!)

I don't think extra seconds will hurt. Better err on the side of caution.

_________________15 year old - asthmatic, allergic to cats, dogs, horses, waiting to be "officially" diagnosed for anaphylaxis
12 year old - asthmatic, allergic to tree pollen and mold, OAS
Husband - Allergic to amoxycillin
Self - Allergic to housework only

I would also err on the side of caution and hold the injector in for as long as you can...the only thing is, with a young child that's not always so easy... It's nice to know that if you *can't* for whatever reason, the person *should* get the dosage they need to reverse a reaction. (by posting, hopefully others won't feel the same panic I felt when I wasn't able to keep the injector in place for the required 10 seconds)

With the junior being recommended for kids 15 to 30 kg...I'm sure a lot of you guys, like me, also have kids under 30kg who currently have a regular. Do you guys plan on switching back to a junior ( or a junior twinject with the same weight dosing between junior and regular as epipen)?

I don't plan on switching mine. My 7 year old weighs 27kg and I've just got new Epipens about two weeks ago. I've been told by King Pharma Canada, and such was my understanding, that the higher dose will not harm him. He's so close that I will not worry about it. By the time these expire he will probably weigh more than 30 kg.

Interestingly, about a month ago I was renewing my 31/2 year olds Epipens. He weighs 18 kg, and my allergist had prescribed the Junior. However the pharmacist was insisting that he needed to get the regular as he was more than 15kg. I simply said that I appreciated her concern but that I needed to trust my allergist on this one. I'm glad I went along with his recommendation as I don't know what I would do with an adult dose for him at this point.

It is certainly a valid question that perhaps your allergist can guide you with.

I do wish there was more black and white when it comes to allergies and much less grey!! It's the grey that is hard to manage!

As far as I'm concerned, it should be the allergist who decides what dose to prescribe. It's not just weight that they take into consideration. My allergist says she also looks at the potential severity of the allergy, the size of the person, the age of the child, and other factors, etc.

I have always followed our allergist's guidance, and she moved my guys to the regular EpiPen quite awhile ago, when they were hovering around 40 lbs.

A parent at our school told me that when she gave her husband an expired epi pen to test on an orange, he pushed the whole pen through the orange. She reminded him that in the future, that could be their son's leg!

_________________15 year old - asthmatic, allergic to cats, dogs, horses, waiting to be "officially" diagnosed for anaphylaxis
12 year old - asthmatic, allergic to tree pollen and mold, OAS
Husband - Allergic to amoxycillin
Self - Allergic to housework only

I guess if an allergist didn't want to prescribe the EpiPen Jr. you would be required to have epinephrine in a vial and a syringe, and measure out the dose... That's what they had to do before the EpiPen came on the scene, and that's what paramedics and doctors would do.

I remember a friend telling me years ago that she babysat a little boy with a severe dairy allergy and she had to do that when he reacted. I always admired her for doing that, even before I knew about my own kids.

A parent at our school told me that when she gave her husband an expired epi pen to test on an orange, he pushed the whole pen through the orange. She reminded him that in the future, that could be their son's leg!

My DH did the exact same thing. I just looked at him and said, "You realize that is your son's thigh right there...?" Needless to say, next time he was much gentler (with the orange).

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